Provider First Line Business Practice Location Address:
1012 W. INDIANA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KOUTS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46347-9703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-766-2999
Provider Business Practice Location Address Fax Number:
219-766-2704
Provider Enumeration Date:
02/09/2006